Employee & Community Health

Breast cancer FAQs: What you need to know

10/6/2016
by
Dr. Summer Allen

October is Breast Cancer Awareness Month, and your Care Team wants to answer your questions about breast cancer screening, mammography and self-care. If you have more questions, please talk with your providers.

A: The top-two risk factors for breast cancer are gender (female) and age (risk increases with age). Recommendations for screening will be different for some women, including those with:

History of breast cancer (including a diagnosis of ductal carcinoma in situ)

Genetic mutations, such as BRCA1 and 2, known to place women at higher risk

History of chest radiation

Q: What about women with breast cancer in their family?

A: Women with a mother, sister or daughter diagnosed with breast cancer have a different risk than other women. They should talk with their health care provider about recommendations for when to start screening and how often they should be screened.

Women ages 50 to 74 are most likely to benefit from screening, and it's most beneficial if done every two years.

Women in their 40s have a lower risk of developing breast cancer, so the value of screening is lower for them. Screening before age 50 should be based on a woman's personal values, preferences, health history and a thorough discussion with her health care provider.

Evidence showing the benefit of screening for women age 75 and older is limited, so a recommendation for or against it can't be made at this time.

Q: Are there risks associated with screening?

A: The guidelines are intended to provide the greatest benefit to patients while reducing potential harm. The possible risks associated with screening include:

Over-diagnosis: Being diagnosed and receiving treatment for a type of breast cancer that would have no effect on a women's life.

Health-related anxiety: Caused by awaiting results from initial screening or when additional testing is needed.

Watch this video from the USPSTF about these guidelines.

Q: Do all the experts agree on breast-cancer screening recommendations?

A: There are differences between the recommendations from other organizations. For example:

American Cancer Society

Strongly recommends screening mammography starting at age 45

Recommends annual screening for those age 45 to 54

Recommends screening every other year for those 55 and older, as long as overall health and life expectancy support continued screening

The American College of Obstetrics and Gynecology and National Comprehensive Cancer Network recommend annual screening mammography starting at age 40.

Mayo Clinic

Continues to offer annual screening mammography starting at age 40

Encourages you to have a discussion with your health care provider about your individual preferences and health history in order to make an informed and shared decision regarding mammography screening

Is working on a decision aid to help our patients better understand the potential benefits and limitations related to breast cancer screening and to facilitate the discussion with their provider

Q: What is the link between breast density and cancer?

A: Breast density, which is the proportion of milk glands and ducts to fat, is determined by a mammogram and the radiologist reading the image. The density levels are A (fatty breast), B (mild density), C (moderate density) or D (extremely dense).

Those with dense breasts are at increased risk for developing breast cancer, compared to women with primarily fatty breast tissue. As a result, many states have developed legislation to ensure that women are informed of their breast density following a mammogram.

The USPSTF recently reviewed the evidence regarding additional screening for women with dense breasts and found that it doesn't clearly indicate that more screening is beneficial. Consequently, it doesn't make a recommendation for or against more screening.

Options for additional screening include tomosynthesis, molecular breast imaging, ultrasound or breast magnetic resonance imaging (MRI). Our health care providers recommend that you have a discussion with your provider about the risks and benefits of supplemental screening and your options so that you can make a choice based on your preferences.

Dr. Summer Allen is a Family Medicine physician within Employee and Community Health's (ECH) Department of Family Medicine. She has an interest in women's health - with a special interest in breast cancer, screening and preventive health - obstetrical care and population health. She also serves as a leader for Mayo Clinic in the area of Patient Engagement with a goal of understanding what our patients desire from health and health care.

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